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Thursday, March 1, 2012

snarky

I try not to be snarky about things in which I have no formal training. Homeopathic, complementary, alternative, and untested (excluding clinical trials, of course) therapies fall into that category. Sometimes this is difficult as I have encountered many patients who have lost the last of their time and money on such treatments. Or as in the case of Dr. Burzynski, who, over 30 years from his discover of "antineoplastons", still has yet to publish data from a randomized, controlled study in a peer-reviewed journal (And it might be mentioned, also threatened to sue a 17 year old who blogged critically of his purported cancer therapy. Say what you will about pharmaceutical companies, but they don't generally go around suing high schoolers for defamation.)

Given what I have to offer is literally a form a poison, I do understand why patients ask for more "natural" remedies. And their inquiry is not entirely without merit if you consider that some of our most commonly used drugs, like the vinca alkaloids, were derived from plants. However, despite this "natural" origin, no one would categorize vinblastine as anything other than standard, and thus toxic, chemotherapy. And one that has proven its efficacy in clinical trials. I try to work with patients on this issue - explain that I do not object if the patients wants to incorporate a diet high in vitamin C or the occasional coffee ground enemas into standard chemotherapy, on the condition that the patient tells me what additional therapies they are trying and that the patient understands there is a possibility the alternative (or "complementary") therapy could adversely interact with their chemo in ways I cannot predict.

I am on maternity leave right now, so it is perhaps strange that I have spent the morning googling Dr. Burzynski (although truthfully quite helpful as I really do get asked about the Burzynski Clinic often). I started thinking about this issue when I noticed the tag on the "Mother's Milk" tea I have been drinking two or three times a day -

That says "Traditional Medicinals". My first reaction was "Oh no you don't. It's me, being a practitioner of "westernized" medicine, that is the "traditional" one here. You, my homeopathic tea, are the "alternative". In my world, tea is no more medicinal than the vinca alkaloids are natural. And for the record I don't talk to my tea.

I started drinking this tea "just because", and more as novelty than because I worried about my milk supply. That being said, in the last few weeks my milk has been "coming in" more frequently than I remember it doing when I was nursing my daughter. I really don't know how proven a galactagogue fenugreek is, but in my case (the worst kind of evidence - anecdotal...) it certainly seems to be working.

And so I find myself in the odd position of feeling both snarky towards the makers of this "medicinal" tea and yet not able to go an hour without the need to nurse or pump. Of course, the answer could be as simple as it just works, although I would feel better about recommending it should its efficacy be proven in a randomized trail published in a peer-review journal.

I've heard of that Burzynski "doctor" and how someone went there and asked about the treatment - apparently, they charge you a thousand dollars up front just to see him, and then you have to pay the cost of the treatment before you get anything done. No thanks - ill stick with my evidence based medicine, thank you very much.

Great that you are "respectfully skeptical" of both Western pharmaceutical treatments and of traditional or naturopathic treatments. As a user of both, I like the term complementary the best. Patients should be supported in their efforts to complement their therapies by understanding and knowledgeable doctors. Most naturopathic or alternative therapies just cannot fit the randomized control study model. Let's not forget that some of these methods have a much more "robust" use historically than many of our newer methods. As long as complementary methods don't harm our patients, I'm all for their use.

In the word of a great doctor "where will our next ideas come from if not evidenced based." We have no mechanisms of actions for about 1/3rd of common meds used today. You can also only find evidence if you look. My literature is your literature. www.pubmed.gov - fenugreek and lactation - at least 15 studies in peer reviewed journals. On the other hand, it's been used for >200 years, is cheap, tastes good and works for you. Who decides the evidence. Personally, the longer I'm in medicine, the more convinced I am that standard of care is set by Television.

I hink it's a shame more medical schools arent incorporating some form of complementary medicine such as supplements in to their programs - I guess it's a little like chronic pain if you cant see it (it being evidence apparently in this case?) then it doesnt exist and thus cant be help/cant help? It is a shame more doctors arent willing to think outside the box. To me the biggest sham is when medications such as the fish oil that was marketed via commercials about a year ago many times over as 'being better than anything you can by at a store' (or something like that) in why sometims supplements ARE better than pharmaceuticals - really would you want to give your patient a doctoed up (no pun intended, accepy my apology) chemical filled fish oil or send them to a privately owned health store run by a trained nutritionist where they can get fish oil that is pure and less costly and proven? It is a shame it is always western vs complementary and not western with complementary! Ive seen this Dr.Burszynski's video (cant remember who it was done by in which he was sued by the govt many times over and he was always able to win) and it seems like instead of assuming his treatment doesnt work maybe more doctors should be studying it??? What kills more cancer patients now? Chemo I believe? I personally if given a diagnosis like say ovarian cancer would never do these treatments that basically kill patients and offer absolutely no quaility of life. I dont mean to rant here but again it seems ridiculous (and I really like your posts usually as a patient myself with a rare disorder) that it has to be tradt'l medicine (western) or nothing. :(

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